全麻剖宫产术中应用 Supreme 喉罩与气管插管进行气道管理的效果比较：一项随机对照试验。
Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial.
机构信息
Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women's Hospital, Quanzhou, Fujian Province, China.
Department of Anesthesiology, Qinghai University Affiliated Hospital, Xining, Qinghai Province, China.
出版信息
BMC Anesthesiol. 2019 Jul 8;19(1):123. doi: 10.1186/s12871-019-0792-9.
BACKGROUND
The obstetric airway is a significant cause of maternal morbidity and mortality. Endotracheal intubation is considered the standard of care but the laryngeal mask airway (LMA) has gained acceptance as a rescue airway and has been incorporated into the obstetric airway management guidelines. In this randomized controlled equivalence trial, we compared the Supreme LMA (SLMA) with endotracheal intubation (ETT) in managing the obstetric airway during cesarean section.
METHODS
Parturients who underwent elective cesarean section under general anesthesia were randomized to receive either an SLMA or ETT as their airway device. Our primary outcome was first-attempt insertion success. Successful insertion was defined as adequate bilateral air entry with auscultation and the presence of end-tidal carbon dioxide on the capnogram. The first-attempt insertion success rate was compared using the Chi-Square test. Secondary outcomes included time-to-ventilation, seal pressure, ventilation/hemodynamic parameters, occurrence of clinical aspiration, fetal outcomes, and maternal side effects associated with the airway device.
RESULTS
We recruited 920 parturients (460 SLMA, 460 ETT) who underwent elective cesarean section under general anesthesia. Patient characteristics were similar between the groups. First attempt success was similar (Odds Ratio--OR: 1.00 (95%CI: 0.25, 4.02), p = 1.0000). SLMA was associated with reduced time to effective ventilation (Mean Difference--MD -22.96; 95%CI: - 23.71, - 22.21 s) compared to ETT group (p < 0.0001). Ventilation parameters, maternal and fetal outcomes were similar between the groups, and there was no aspiration.
CONCLUSIONS
SLMA could be an alternative airway management technique for a carefully selected low-risk obstetric population, with similar insertion success rates, reduced time to ventilation and less hemodynamic changes compared with ETT. Our findings are consistent with the airway guidelines in recommending the second-line use of LMA in the management of the obstetric airway.
TRIAL REGISTRATION
The study was registered at http://www.clinicaltrials.gov , identifier: NCT01858467 , retrospectively registered. Date of registration: May 21, 2013.
背景
产科气道是产妇发病率和死亡率的重要原因。气管插管被认为是标准的护理方法，但喉罩气道（LMA）已被作为一种抢救气道而被接受，并已被纳入产科气道管理指南。在这项随机对照等效试验中，我们比较了 Supreme LMA（SLMA）与气管插管（ETT）在剖宫产术中管理产科气道的效果。
方法
接受全身麻醉下择期剖宫产的产妇被随机分为 SLMA 或 ETT 作为气道装置。我们的主要结局是首次尝试插入成功。成功插入定义为听诊时双侧空气进入良好，呼气末二氧化碳在呼末二氧化碳图上存在。使用卡方检验比较首次尝试插入成功率。次要结局包括通气时间、密封压、通气/血液动力学参数、临床误吸的发生、胎儿结局以及与气道装置相关的母体副作用。
结果
我们招募了 920 名接受全身麻醉下择期剖宫产的产妇（460 名 SLMA，460 名 ETT）。两组患者的特征相似。首次尝试成功率相似（比值比 -OR：1.00（95%CI：0.25, 4.02），p=1.0000）。与 ETT 组相比，SLMA 组通气时间更短（平均差异 -MD -22.96；95%CI：-23.71, -22.21 秒）（p<0.0001）。通气参数、母婴结局相似，无误吸。
结论
SLMA 可作为一种替代气道管理技术，用于精心挑选的低风险产科人群，其插入成功率相似，通气时间更短，血液动力学变化更小，与 ETT 相比。我们的研究结果与气道指南一致，指南建议在管理产科气道时将 LMA 作为二线治疗方法。
试验注册
该研究在 http://www.clinicaltrials.gov 上注册，标识符：NCT01858467，为回顾性注册。注册日期：2013 年 5 月 21 日。
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